机器人辅助根治性前列腺切除术在既往腹部手术中的应用：单外科医生系列中的围手术期结果、肿瘤学和功能结果以及并发症。

Robot-assisted radical prostatectomy in the setting of previous abdominal surgery: Perioperative results, oncological and functional outcomes, and complications in a single surgeon's series.

机构信息

Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland; Dept. of Obstetrics and Gynecology Sciences and Urologic Sciences, 'Sapienza' University, Rome, Italy.

Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.

出版信息

Int J Surg. 2016 Dec;36(Pt A):170-176. doi: 10.1016/j.ijsu.2016.10.038. Epub 2016 Oct 27.

DOI:10.1016/j.ijsu.2016.10.038

PMID:27989916

Abstract

BACKGROUND

Data on safety and efficacy of robot-assisted radical prostatectomy (RARP) after previous abdominal surgery are scarce. Hence, we assessed perioperative, oncological and functional outcomes, and complications of RARP in patients with previous abdominal surgery after 1-year minimum follow-up.

MATERIALS AND METHODS

Prospectively collected data from 339 consecutive patients undergoing transperitoneal RARP by a single surgeon (AM) between November 2008 and May 2014 were analysed. Complications were classified according to Modified Clavien System. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml. Functional outcomes were assessed using validated, self-administered questionnaires. In particular, only patients undergoing nerve-sparing RARP with no erectile dysfunction (baseline IIEF-5 score >21) and no use of phosphodiesterase-5 inhibitors preoperatively who were interested in erections and required no adjuvant therapy (radiation, orchiectomy and androgen-deprivation therapy) were evaluated concerning potency recovery. Patients without and with previous abdominal surgery were compared using Mann-Whitney and chi-square tests (or Fisher exact test).

RESULTS

On 339 patients, 247 (71.6%) had not undergone previous abdominal surgery (Group 1) and 92 (28.4%) were pre-operated (Group 2). There were no statistically significant differences between Groups 1 and 2 regarding mean operative time (260 vs. 257 min; p = 0.597), median number of resected nodes (16 vs. 17; p = 0.484), mean length of stay (7.2 vs. 7.1 d; p = 0.151), positive surgical margin (12.5% vs. 16.3%; p = 0.233) and complication rates (26.7% vs. 31.5%; p = 0.187). Median (IQR) follow-up was 36 (12-48) months. For Groups 1 and 2, BCR-free survival rates were 78.5% and 79.8% (p = 0.467); continence rates were 97.9% and 100% (p = 0.329), whereas a potency recovery was achieved in 69.5% and 62.2% of patients (p = 0.460), respectively.

CONCLUSIONS

Transperitoneal RARP is a safe and efficient treatment for clinically localised prostate cancer even in patients with previous abdominal surgery. However, further studies with higher number of patients are warranted.

摘要

背景

先前腹部手术患者行机器人辅助根治性前列腺切除术（RARP）的安全性和疗效数据稀缺。因此，我们评估了单外科医生（AM）在 2008 年 11 月至 2014 年 5 月间施行的 339 例经腹腔 RARP 患者的围手术期、肿瘤学和功能结局以及并发症，随访时间至少 1 年。

材料和方法

前瞻性收集了 339 例连续接受 AM 施行的经腹腔 RARP 患者的数据。并发症根据改良 Clavien 系统分类。生化复发（BCR）定义为连续两次 PSA 值均≥0.2ng/ml。使用经过验证的自我管理问卷评估功能结局。特别地，仅对接受神经保留 RARP 且无勃起功能障碍（基线 IIEF-5 评分＞21）且术前未使用磷酸二酯酶-5 抑制剂、对勃起有兴趣且无需辅助治疗（放疗、睾丸切除术和雄激素剥夺治疗）的患者进行评估，以了解勃起功能的恢复情况。无先前腹部手术史的患者（第 1 组，n=247）和有先前腹部手术史的患者（第 2 组，n=92）之间的比较采用 Mann-Whitney 和卡方检验（或 Fisher 确切概率法）。

结果

在 339 例患者中，247 例（71.6%）无先前腹部手术史（第 1 组），92 例（28.4%）有腹部手术史（第 2 组）。第 1 组和第 2 组之间的平均手术时间（260 分钟 vs. 257 分钟；p=0.597）、中位切除淋巴结数量（16 枚 vs. 17 枚；p=0.484）、中位住院时间（7.2 天 vs. 7.1 天；p=0.151）、阳性切缘率（12.5% vs. 16.3%；p=0.233）和并发症发生率（26.7% vs. 31.5%；p=0.187）均无统计学差异。第 1 组和第 2 组的无 BCR 生存率分别为 78.5%和 79.8%（p=0.467）；尿控率分别为 97.9%和 100%（p=0.329），而勃起功能恢复率分别为 69.5%和 62.2%（p=0.460）。